{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T08:24:32Z","timestamp":1781598272992,"version":"3.54.5"},"reference-count":33,"publisher":"American Society for Microbiology","issue":"8","license":[{"start":{"date-parts":[[2024,8,7]],"date-time":"2024-08-07T00:00:00Z","timestamp":1722988800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/doi.org\/10.1128\/ASMCopyrightv2"},{"start":{"date-parts":[[2024,8,7]],"date-time":"2024-08-07T00:00:00Z","timestamp":1722988800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"funder":[{"DOI":"10.13039\/100000738","name":"U.S. Department of Veterans Affairs","doi-asserted-by":"crossref","award":["IK2BX005609"],"award-info":[{"award-number":["IK2BX005609"]}],"id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Antimicrob Agents Chemother"],"published-print":{"date-parts":[[2024,8,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:sec>\n            <jats:title\/>\n            <jats:p>\n              In contrast to the epidemiology 10 years earlier at our hospital when the epidemic restriction endonuclease analysis (REA) group strain BI accounted for 72% of\n              <jats:italic>Clostridioides difficile<\/jats:italic>\n              isolates recovered from first-episode\n              <jats:italic>C. difficile<\/jats:italic>\n              infection (CDI) cases, BI represented 19% of first-episode CDI isolates in 2013\u20132015. Two additional REA group strains accounted for 31% of isolates (Y, 16%; DH, 12%). High-level resistance to fluoroquinolones and azithromycin was more common among BI isolates than among DH, Y, and non-BI\/DH\/Y isolates. Multivariable analysis revealed that BI cases were 2.47 times more likely to be associated with fluoroquinolone exposure compared to non-BI cases (95% confidence interval [CI]: 1.12\u20135.46). In addition, the odds of developing a CDI after third- or fourth-generation cephalosporin exposure was 2.83 times for DH cases than for non-DH cases (95% CI: 1.06\u20137.54). Fluoroquinolone use in the hospital decreased from 2005 to 2015 from a peak of 113 to a low of 56 antimicrobial days\/1,000 patient days. In contrast, cephalosporin use increased from 42 to 81 antimicrobial days\/1,000 patient days. These changes correlated with a decrease in geometric mean MIC for ciprofloxacin (61.03 to 42.65 mg\/L,\n              <jats:italic>P<\/jats:italic>\n              = 0.02) and an increase in geometric mean MIC for ceftriaxone (40.87 to 86.14 mg\/L,\n              <jats:italic>P<\/jats:italic>\n              &lt; 0.01) among BI isolates. The BI strain remained resistant to fluoroquinolones, but an overall decrease in fluoroquinolone use and increase in cephalosporin use were associated with a decrease in the prevalence of BI, an increased diversity of\n              <jats:italic>C. difficile<\/jats:italic>\n              strain types, and the emergence of strains DH and Y.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1128\/aac.00698-24","type":"journal-article","created":{"date-parts":[[2024,7,2]],"date-time":"2024-07-02T13:01:23Z","timestamp":1719925283000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":6,"title":["Epidemiology of\n            <i>Clostridioides difficile<\/i>\n            infection at one hospital 10 years after an outbreak of the epidemic\n            <i>C. difficile<\/i>\n            strain BI\/027: changing strain prevalence, antimicrobial susceptibilities, and patient antibiotic exposures"],"prefix":"10.1128","volume":"68","author":[{"given":"Jeffrey T.","family":"Wieczorkiewicz","sequence":"first","affiliation":[{"name":"Clinical Pharmacy, Edward Hines Jr., VA Hospital, Hines, Illinois, USA"},{"name":"Department of Pharmacy Practice, Midwestern University Chicago College of Pharmacy, Downers Grove, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9452-9316","authenticated-orcid":true,"given":"Andrew M.","family":"Skinner","sequence":"additional","affiliation":[{"name":"Research and Infectious Diseases Section, George E Wahlen VA Medical Center, Salt Lake City, Utah, USA"},{"name":"Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Cheknis","sequence":"additional","affiliation":[{"name":"Research Section, Edward Hines Jr., VA Hospital, Hines, Illinois, 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